Updated AAN guideline outlines treatments for infantile spasms

The American Academy of Neurology has issued an updated guideline outlining the best treatments for infantile spasms, a rare type of seizure that can occur in infants and young children. The guideline, which was co-developed with the Child Neurology Society, is published in the June 12, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Infantile spasms is a rare disorder that usually begins in infants aged four to six months. The spasms are a type of seizure that mainly consists of a sudden bending forward of the body with stiffening of the arms and legs or arching of the back while the arms and legs are extended. Infantile spasms rarely respond to the usual anti-seizure medications. Most children with infantile spasms have developmental disabilities later in life.

The guideline found that the hormone therapy adrenocorticotropic hormone, also known as ACTH, may be effective for treatment of infantile spasms. The seizure drug vigabatrin may also be considered for treatment, although evidence suggests ACTH may be more effective than vigabatrin. For children with seizures caused by the genetic disorder tuberous sclerosis complex, however, vigabatrin may be more effective.

The guideline, which is based on a review of all available evidence on treatment for infantile spasms and is an update of a guideline published in 2004, also found that low-dose ACTH is probably as effective as high-dose ACTH and it may lower the risk of side effects.

There is not enough evidence to know whether other treatments, alone or combined, are effective in treating infantile spasms, according to the guideline.

The guideline recommends that early diagnosis and early treatment may lead to better long-term outcomes for children's development and learning skills.

"It is important for parents to talk to their child's doctor if they suspect their child may be having seizures or spasms because early diagnosis and treatment may help in the long term with educational and learning skills," said guideline author Cristina Go, MD, of the Hospital for Sick Children in Toronto.

Go noted that children with the syndrome also have a specific pattern that shows up in tests of brain waves, and an EEG (electroencephalogram) is required for confirmation of the diagnosis.